Day 70 – A Bit Confused?

August 31, 2013

I left on a Sunday to Toronto to see my Doctor on Monday morning. As a note, my last appointment with the physiotherapist was on the Wednesday. So by the time I saw the doctor on Monday, five days had passed since I’d had my last physiotherapy session. I sat down with Doctor Steven McCabe and his staff including some other surgeons and students and we reviewed my progress. Unfortunately the news was not good or as good as I would like it to be. My fingers are still swollen and my movement was limited in the wrist. I asked the doctor if this was normal and he responded that it was not and that the swelling in the fingers had definitely slowed down my healing process. I explained to him about the aching in my fingers and also about how it felt like nerves were firing inside my fingers at night while I slept. He asked me if I was wearing the brace at night while I slept and I responded no because the physiotherapist told me not to. He said that I should be wearing it at night and that it will help with the aching and the nerve firing as well as keeping my hand up whenever possible to help with the swelling. I asked him how long this would take to heal and he really didn’t have an answer other than to keep doing my exercises and not to give up and that they think it will get better. I questioned his choice of word “think”and he said that they cannot say 100% that I will improve but they think I will if I continue doing these exercises. He pointed out the improvements I’ve made since my last visit and he said he would like to see me in two months. He encouraged me not to give up and to continue religiously with these exercises.

Funny enough, I drove home after his visit and when I went to bed I decided I would use the brace as he suggested and I also went back to sleeping on my back with my hand up on one pillow [above my heart]. To my surprise, I woke up and was able to move my fingers up and down without doing any of my early morning stretching exercises. This was a huge improvement. Normally every morning I would wake up and my fingers would be curled and stiff I would not be able to move my fingers up or down without stretching them for 5 to 10 minutes in the morning. But this morning I woke up and was able to stretch my fingers myself, and they felt great! For the rest of the day my fingers felt much better and I was able to do many more things that I could not do last week. For example, I had the strength to use a Peppermill at dinner for the first time.

On Wednesday I had an appointment with the physiotherapist. I started to think about what was different today than the last few weeks. Obviously there is the fact that I was not wearing my brace at night and I was not keeping my hand up in the air whenever possible to drain my fingers. However, there’s also the fact that the physiotherapist was manipulating my wrist and I was doing far more exercises to or three times a week. So when I spoke to the physiotherapist and explained how great I felt he too was a bit confused at first because there is always a consequence to exercising, and swelling is one of them. However I asked them to measure my pull strength and it went from 4 kg to 14 kg in seven days. I guess we were both a bit confused at this point in time as to what should be the next course of action. The physiotherapist was leaving for a 2 1/2 weeks vacation to Europe and we agreed that I would continue with my exercises during this time and see how I feel in three weeks when he returns. Now keep in mind that this physiotherapist is not a certified hand therapist but he does do a lot of work with hands in my small town.

I find that every day I wake up now with my fingers able to move except for a full fist closure like making a fist. But it only takes a few seconds to squeeze my fingers shut and I then have full range of motion with my fingers. Now throughout the day they do vary in stiffness depending on what I’m doing, the temperature, humidity etc., however they are not aching and sore like they were before.

So here’s what I am doing now and I am not certain that this may not be the right approach but I do know it is the feel-good approach for now. I am performing my finger exercises regularly throughout the day as well as my wrist exercises. I do find that putting an ice pack on my wrist while I lay down before I go to sleep relieves some of the slight swelling or information that I get by working it throughout the day. I no longer take painkillers during the day at all but I still take my prescribed painkillers just before bed but no others in the middle of the night.

Today I started to take a new pill called Protandim that my partner in Phoenix sent me. I am looking to find a certified hand physiotherapist in Ottawa or Montréal so that I may have one visit with him and get their opinion on what I should be doing. I am also considering crossing the border to Massena and paying the $300 for a MRI of my wrist so that I have a full picture and can give this to my surgeon since the more information we have the better decisions we can make.

Presently I find that I’m able to drive my new Fiat Abarth that is a five-speed standard without any problems, I have much more ability to use my fingers and my wrist does not hurt or ache during the day. As I said before I do get stiff once in a while and I’m not certain if it’s something I ate, the temperature or something else. Yesterday for example I installed LED lights on my wife’s Vespa and was able to use a screwdriver with my right hand [yay!]. I do believe that this hand will heal in time and that I will regain the use of my fingers. However I am beginning to feel that my wrist will bend inwards by approximately 30 to 40° and bending outwards will be little to no degrees. Presently I have between 0 to 10° outwards depending on how you measure it. My physiotherapist measures it at ten while my surgeon measures it at zero. If I had 40° inwards and 10° outwards I believe I would be happy with that providing there would be no more pain, aching or other annoying things.

I also paid for my x-rays while I was at the Toronto Western hospital and will be adding them to the explanation page, however below is a picture of the before and after for those who are interested. It’s interesting to see how this shortens my hand. It’s very strange when I hold my hands up in front of me to see that one hand is about an inch or two shorter than my other…

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Good luck getting an MRI if that is what you choose to do. Down here, it seems doctors are spring loaded to wanting to have an MRI done. My first reaction to a doctor recommending an MRI was ‘is that really necessary’, but I’m gradually becoming a believer in them. There is so much more information there, compared to an xray. And a whole lot more expensive, compared to an xray.

I think getting the MRI would be a good idea. Not sure why you would have to go across the border for an MRI. Is that a function of the Canadian Health Care system or is that the closest MRI equipment. Maybe you have some kind of vascular issue that is not allowing blood to be moved out of your hand and it is just collecting there. But it would seem to me that you have shown enough patience with the swelling in your fingers and it is time to find a cause and to not assume at this point that it will work itself out. Maybe a new set of eyes looking at your wrist/hand would be good. Even though I had/have finger discomfort, my fingers were never swollen during this whole process. Other than a hard bump where the incision was made, I don’t have any visible swelling in the wrist.

Last week I had my last meeting with the therapist. Obviously I’m not done, but I can do excersices myself at home. During that last meeting, they had me use a ‘wrist roller’ (2-3 lb weaight at the end of a rope with the other end of the rope attached to a handle and I have to raise and lower the weight by coiling the rope around the handle…that’s harder to describe using words that I thought it woudl be) for the first time. I think that will be a good excersice for working out the remaining bugs in the wrist. They also had me use a ‘velcro board’ where velcro was attached to a board about 12-18 inches long and then I had a roller about the size of a lint roller with the other type of velcro material attached to the cylinder. I had to move the roller towards me and away from me by moving my wrist similiar to moving the throttle on a motorcycle. The velcro acted as the resistence.

Nobody has told me whether I should wear a brace at night (or not) but I choose to wear one. At this point prefer my wrist to be ‘under control’ when I’m sleeping. I’m doing some light swinging of a golf club in the back yard. I also bought a left handed golf club and I’m trying to get a feel for how practical it would be to switch to golfing left handed. At this point in time, the stresses on my left wrist are much less when I swing the club left handed. Who knows, maybe switching to golfing left handed could be a better long term solution. I’m also doing some push ups with push up bars that keep my hands off the floor. For right now I keep my knees on the floor to minimize the amount of weight on my wrist.

I’m only two months out from the surgery. What little there is to read about PRCs and from what my therapist says, the 3 month point is really were things start coming together and I’ll get a feel for what kind of wrist I will have. So I’m trying to show some patience and find a balance between probing to find out what my wrist can do now and still letting it have it’s space and let it continue to firm up over the next month.

And another thing, when my therapist measures range of motion he does it when I make a fist. I have about 45 degrees forward and about 35-40 degrees back. If I straighten my fingers, the forword motion is mostly the same (a little less) but I lose almost all of my backwards range of motion. It is my understanding that is due to the slack in the tendons due to the row of bones coming out. I assume, for comparison’s sake, that making the measurements with a closed fist is some kind of ‘standard’. But I guess I don’t know that for sure. When you give your measurements, you don’t say whether you have a fist or your hand is open. I assume that your measurements are with your hand open.

The MRI is a Canadian thing. If there is no reason to have an MRI, then it is impossible to get one. If the doctor or any doctor orders one, then you would receive one. However, the swollen fingers seem to be something that does happen in 30-40 % of the PRC and is dependent on many factors. My swelling is going down slowly. I spoke with someone who fractured their wrist and still has a bit of swelling after two years. They told me that they had the swelling for the first year. Therefore, my doctor seems to feel that it is not the expected result but also not so unusual to warrant further investigation at this time. But, I agree with your comment and will gladly pay (in the US) for an MRI just to see what the information says.